|© UNICEF/HQ95-0971/ Noorani|
|A health worker uses a flip chart to explain the importance of eating nutritious vegetables during pregnancy to a group of women attending a health education class. Bangladesh|
By 2010, to reduce the infant and under-five mortality rate by at least one third, in pursuit of the goal of reducing it by two thirds by 2015.
Every year, almost 11 million children under the age of five in developing countries die from readily preventable and treatable illnesses such as diarrhoeal dehydration, acute respiratory infections (ARI), measles, and malaria. In half of the cases, illness is complicated by malnutrition.
While improved medical treatment combined with greater access to health care has helped children in many parts of the world, in others huge numbers of children continue to die needlessly. Many of these children were never seen at a health facility -- because services don’t exist, because their families lack access to these services, or because families and other caregivers do not recognize the warning signs of life-threatening illness. In Tanzania, as many as 40 per cent of children who died were never taken for treatment; in Bolivia, the figure has been as high as 74 per cent.
Because most child deaths occur at home, before reaching health facilities, preventing fatalities by improving child health through the community is at the core of the approach called Integrated Management of Childhood Illness (IMCI). This strategy has three main areas of focus: improving health worker skills, improving health systems and improving family and community practices (Community Integrated Management of Childhood Illness, C-IMCI).
UNICEF and its partners, including WHO, advocate for IMCI and give technical assistance to countries who apply it. This includes improving health worker’s case management skills through classroom work and hands-on clinical practice. Particular attention is given to the most common child diseases in developing countries, particularly acute respiratory infections (ARI).
UNICEF also advocates with governments to improve their health systems, including ensuring that essential drugs, supplies and equipment are available. UNICEF helps to buy and distribute these items, including vaccinations for routine immunization, Vitamin A supplements, insecticide-treated nets in malaria-affected areas, and malaria home management kits (prepackaged anti-malarial medications).
UNICEF assists with improving the organization, coordination and management of child health interventions; improving the monitoring and evaluation of health services; and building coordination between health facilities and communities.
Working with governments and communities, UNICEF supports efforts to improve family and community practices. Based on scientific evidence, UNICEF has identified a number of key practices that are crucial to child health and development.
These practices include: breastfeeding and complementary feeding, hygiene (hand washing and safe faeces disposal) and helping to prevent malaria (through consistent use of treated nets, home management of less severe fever episodes, and through recognizing symptoms and promptly referring severe fever cases to a health facility).
More than 80 countries have successfully adopted the integrated management of childhood illness into their health systems; more than 40 countries are giving special attention to improving family and community practices as a key way of reaching vulnerable children.
"We now know that about 90 per cent of the children that die each year, die at home. How children are cared for at home and in their community has a decisive impact on their chances of survival. We need to provide parents and caregivers with essential knowledge and commodities that can save the lives of their children.” – Carol Bellamy, Executive Director of UNICEF
UNICEF promotes these practices among governments, health providers and community leaders. We then help gather and review existing information about existing family practices, assess priorities and form a working group with other partners and non-governmental organizations (NGOs) to mobilize support and tackle the challenges identified.
In districts and communities, UNICEF helps leaders assess existing resources, select areas where community activities can be introduced or enhanced, and involves local groups, such as NGOs and mothers’ groups, in promoting key practices and training the community in prevention and care of common diseases such as anaemia and diarrhoea.
In Tamil Nadu, India, UNICEF supported the Tamil Nadu Science Forum, a non-governmental organization, in working with some 500 villages. The programme organized village health committees each with a local health activist who received specialized training. Activists shared their messages via cultural programmes, village meetings and family visits, as well as organized topic groups and one-on-one sessions with mothers. One key indicator of the programme’s success was the 21.4 per cent improvement in the number of children of ‘normal’ weight.
The results of C-IMCI in Madagascar, where UNICEF worked with the Ministry of Health to set up a national structure to coordinate community-based health care, are striking. The approach has been implemented in 26 out of 111 districts, covering 252,8000 people. In these areas, exclusive breastfeeding increased from 22 to 58.5 per cent; 78 per cent of all households began using mosquito nets and immunization coverage leapt from 31 to 97 per cent.
Global partnerships and initiatives
UNICEF works closely with WHO and other partners in implementing IMCI, its community component (C-IMCI) in particular, and assists the WHO Roll Back Malaria initiative, using community-based actions to educate about malaria prevention and to distribute bed nets and home malaria treatment kits.